Cerebral blood flow in normal aging adults: cardiovascular determinants, clinical implications, and aerobic fitness

<jats:title>Abstract</jats:title><jats:sec><jats:label /><jats:p>Senescence is a leading cause of mortality, disability, and non‐communicable chronic diseases in older adults. Mounting evidence indicates that the presence of cardiovascular disease and risk factors elevates the incidence of both vascular cognitive impairment and Alzheimer's disease (<jats:styled-content style="fixed-case">AD</jats:styled-content>). Age‐related declines in cardiovascular function may impair cerebral blood flow (<jats:styled-content style="fixed-case">CBF</jats:styled-content>) regulation, leading to the disruption of neuronal micro‐environmental homeostasis. The brain is the most metabolically active organ with limited intracellular energy storage and critically depends on <jats:styled-content style="fixed-case">CBF</jats:styled-content> to sustain neuronal metabolism. In patients with <jats:styled-content style="fixed-case">AD</jats:styled-content>, cerebral hypoperfusion, increased <jats:styled-content style="fixed-case">CBF</jats:styled-content> pulsatility, and impaired blood pressure control during orthostatic stress have been reported, indicating exaggerated, age‐related decline in both cerebro‐ and cardiovascular function. Currently, <jats:styled-content style="fixed-case">AD</jats:styled-content> lacks effective treatments; therefore, the development of preventive strategy is urgently needed. Regular aerobic exercise improves cardiovascular function, which in turn may lead to a better <jats:styled-content style="fixed-case">CBF</jats:styled-content> regulation, thus reducing the dementia risk. In this review, we discuss the effects of aging on cardiovascular regulation of <jats:styled-content style="fixed-case">CBF</jats:styled-content> and provide new insights into the vascular mechanisms of cognitive impairment and potential effects of aerobic exercise training on <jats:styled-content style="fixed-case">CBF</jats:styled-content> regulation.</jats:p></jats:sec><jats:sec><jats:label /><jats:p> <jats:boxed-text content-type="graphic" position="anchor"><jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" mimetype="image/png" position="anchor" specific-use="enlarged-web-image" xlink:href="graphic/jnc14234-fig-0008-m.png"><jats:alt-text>image</jats:alt-text></jats:graphic></jats:boxed-text> </jats:p><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1471-4159/homepage/special_issues.htm#Vascular Dementia">This article is part of the Special Issue “Vascular Dementia”</jats:ext-link>.</jats:p></jats:sec>